Registered Nurse Clinical Appeals

Job Summary

A company is looking for a Clinical Denials/Appeals RN.

Key Responsibilities

• Conduct pre and post service medical necessity reviews using evidence-based criteria
• Prepare, submit, and track clinical appeals while collaborating with various teams to resolve denials
• Maintain accurate documentation of all review activities in compliance with standards

Required Qualifications

• Current unrestricted Registered Nurse license in the state of residence
• University Degree with 4-6 years of relevant acute care clinical experience
• Prior experience in clinical denials, utilization review, case management, or appeals
• Experience with InterQual and/or Milliman Care Guidelines and electronic medical record systems
• Bachelor of Science in Nursing or higher preferred